Varice - Wikipedia Esophageal varices - Overview - Mayo Clinic

Funcția principală a sistemului venos în circulația sângelui este drenarea sângelui de la periferie spre inimă, fără a fi obligatoriu, cu varice vizibile.

Varices are dilated submucosal veins, most commonly detected in the distal esophagus or proximal stomach. Varices are associated with portal hypertension of any cause including presinusoidal portal vein thrombosissinusoidal cirrhosis and postsinusoidal Budd Chiari syndrome causes the commonest being cirrhosis. The most important predictor of hemorrhage is the size of varices; the larges varices are at highest risk of bleeding.

In cirrhosis, portal pressures initially increase as a consequence of resistance to blood flow within the liver. This resistance is due mainly to fibrous tissue and regenerative nodules in the hepatic parenchyma.

In addition to this structural resistance, there is intrahepatic vasoconstriction. This is believed to be due to decreased production of endogenous nitric oxide. However, portal hypertension occurs despite the compensatory formation click at this page collaterals for 2 reasons: Varices are portosystemic collaterals that form after pre-existing vascular channels are dilated by portal hypertension.

Dilation generally is clinically significant once the hepatic venous pressure gradient HVPG is elevated above 12mm Hg normal mm Hg. The HVPG is defined as the gradient between the wedged hepatic venous pressure WHVP and the free hepatic venous pressure. The WHVP is measured by a threading a varice în inimă down through the jugular vein into a hepatic vein and wedging it into a smaller branch. Nonbleeding varices are generally asymptomatic. Once varices are bleeding, patients classically present with symptoms of an upper gastrointestinal hemorrhage such at varice în inimă, passage of black or bloody stools, varice în inimă, or decreased urination.

Associated signs of variceal hemorrhage include decompensated liver function manifested as jaundice, hepatic encephalopathy, worsened or new-onset ascites. Physical examination will likely reveal hypotension or shock in severe cases varice în inimă, pallor and stigmata varice în inimă chronic liver disease such as spider angiomatas, palmar erythema, gynecomastia, or splenomegaly. A rectal examination should be performed on all patients without varice în inimă bleeding.

A black tarry stool on the gloved finger suggests an upper gastrointestinal source, and further workup needs to be pursued. Hemoccult testing is not necessary because clinically significant bleeding should be apparent with visual inspection of the stool alone. The gold standard for the diagnosis of varices is esophagogastroduodenoscopy EGD.

It is generally recommended that patients with cirrhosis undergo elective endoscopic screening for varices at the time of diagnosis and periodically thereafter if no or small varices are detected Figure 1. If screening EGD reveals appreciable esophageal varices, a varice în inimă classification should be assigned. Different size classification systems have been used over the years; however, a recent consensus meeting proposed that varices be varice în inimă in only two grades, small and large.

An appropriate cut-off was determined to be 5mm; that is, small varices are those less than 5mm and large varices are those greater than 5mm. Another procedure that is currently being studied for screening for varices is esophageal capsule endoscopy. Pilot studies suggest it is safe and well tolerated and does not require sedationalthough its sensitivity and cost effectiveness still need to be established.

The diagnosis of variceal hemorrhage is secured when endoscopy shows one of the following: Practice guidelines have been formulated by the American Association of Study of Liver Diseases AASLD regarding the prevention and management of gastroesophageal varices and variceal hemorrhage here cirrhosis.

Treatment of varices is best considered in three distinct phases: If a patient has small varices that have never bled and has no risk factors for a first variceal hemorrhage like high Child-Pugh score, continued alcohol use and presence of red wale markings, prophylactic strategies can be considered, although the long-term benefit has not been established. In our practice, primary prophylaxis for bleeding has often been reserved for those who have small varices with risk factors listed above and for all patients with large varices.

The primary pharmacologic strategy for preventing variceal hemorrhage is use of nonselective beta blockers, particularly propranolol and nadolol. These medications reduce portal pressures both by decreasing cardiac output and by producing splanchnic vasoconstriction. A meta-analysis has also showed a statistically significant decrease in overall mortality.

Selective beta-blockers, such as atenolol and metoprolol, are less effective and are not varice în inimă recommended for primary prophylaxis. Likewise, use of isosorbide mononitrate alone or with nonselective beta blockers is not currently recommended. Propranolol is usually started at a dose of 20 mg twice daily and nadolol at a dose of 40 mg daily.

Unfortunately, beta blockers have some significant side effects, so often the dose is simply adjusted to a maximally tolerated dose. The most common side effects reported are lightheadedness, fatigue, shortness of breath, and impotence in men. Relative contraindications varice în inimă the use of beta blockers include reactive airways disease, insulin-dependent diabetes with episodes of hypoglycemiaand peripheral vascular disease.

Patients who meet criteria for primary prophylaxis but who cannot tolerate or have contraindications to beta blocker therapy should be considered for prophylactic endoscopic variceal ligation EVL. Although studies have been conflicting, a recent consensus panel of experts concluded that both nonselective beta blockers and EVL are effective in preventing first variceal hemorrhage.

The decision on whether to treat pharmacologically or via EVL should be based on patient characteristics and preferences, local resources, and expertise. Nitrates either alone or in combination with blockersshunt therapy, or sclerotherapy should not be used in the primary prophylaxis of variceal hemorrhage.

Cirrhotic patients with suspected acute variceal hemorrhage should be admitted directly to an intensive care unit setting for frequent monitoring and aggressive management Figure 2. While still in the emergency department, initial resuscitation can begin by securing large-bore IVs and sending bloodwork varice în inimă the lab, including a type and varice în inimă for blood products. Volume resuscitation should be undertaken promptly but with caution because vigorous resuscitation can actually increase portal pressures to levels varice în inimă than baseline, thereby prompting rebleeding.

In our practice usually start the resuscitation with normal saline and switch to blood or albumin or bothonce available, with the goal to maintain hemodynamic stability. Please click for source of fresh frozen plasma and platelets can be considered in patients with a severe coagulopathy or thrombocytopenia.

Low threshold should be taken to intubate the patient for airway protection, particularly if the patient is in shock or encephalopathy, because aspiration of blood often occurs. Antibiotics are routinely administered in cirrhotic patients who are admitted to the hospital with variceal hemorrhage.

Several randomized clinical trials were able to show varice în inimă antibiotics not only decreased the rate of bacterial infection varice în inimă these patients but also decreased the incidence of early rebleeding and increased overall survival.

The optimal antibiotic and duration is unclear, because benefit was source from many different regimens.

In general, oral norfloxacin at doses of mg twice daily for 7 days or IV ciprofloxacin in patients in whom oral administration is not possible is the recommended antibiotic. In patients with advanced cirrhosis varice în inimă at hospitals with a high incidence of quinolone resistance, ceftriaxone at a dose of 1g Varice în inimă daily may be preferable. Pharmacologic therapy to decrease portal pressures is source important and should varice în inimă considered first-line treatment for acute variceal hemorrhage.

It should be initiated as soon as the diagnosis of variceal hemorrhage is suspected and before EGD. The most common pharmacologic agent used in the United States for this purpose is octreotide, a somatostatin analogue that causes splanchnic vasoconstriction. This agent should be administered ideally for 5 visit web page, even after bleeding is controlled.

Vasopressin most often used with nitroglycerin is the most potent splanchnic vasoconstrictor, but varice în inimă is rarely used for control of variceal hemorrhage due to its multiple varice în inimă side effects including myocardial and mesenteric ischemia and infarction.

Terlipressin is a vasopressin analogue that has significantly fewer side effects. It is effective in continue reading variceal hemorrhage and reducing mortality. It is administered at an initial dose of 2mg IV every 4 hours and then titrated down to 1mg every 4 hours once bleeding varice în inimă controlled.

Terlipressin is currently used extensively in other parts of the world but is not widely available in the United States.

Even though pharmacologic therapy can be effective at controlling suspected variceal hemorrhage, EGD should be performed as soon as possible to confirm the diagnosis and implement endoscopic therapy. Sclerotherapy, widely used in the past, is now nearly obsolete because of risk of complication and improvement in EVL devices. Indeed, recent ulcer trofice animale determined EVL to be the preferred form of endoscopic therapy for acute esophageal variceal bleeding, although sclerotherapy is still recommended in patients in whom EVL is not technically feasible.

Gastric varices, which are often not amenable to either EVL or sclerotherapy, may be more difficult to treat. Varice în inimă glue injected directly into the varix has been shown to be effective for control of bleeding gastric varices. If this agent is not available or in the case of an inexperienced operator, TIPS should be considered as first line therapy.

Portal decompressive therapy, either shunt surgery or TIPS, should then be considered. As TIPS has become more widely available, this is becoming the preferred decompressive procedure.

However, performance of either TIPS or shunt surgery largely depends on local expertise. Because TIPS and cum pentru tratarea varicoase de are both invasive procedure with a high risk of complication, they are varice în inimă for patients who fail pharmacologic and endoscopic therapy.

A randomized controlled trial recently reported reduced mortality and rebleeding rates with early TIPS within 48 hours after variceal hemorrhage. However, this needs to be validated with further Balloon tamponade applies direct pressure varice în inimă the ruptured varix and can be highly effective for immediate control of variceal hemorrhage.

Unfortunately, recurrent bleeding is common after the balloon is decompressed, and balloon tamponade is associated with potentially fatal complications such necrosis or perforation of the esophagus. Therefore, tamponade should be used only as a rescue procedure and a bridge to more definitive therapy maximum 24 tromboflebită și bodyagisuch click at this page TIPS, in cases of uncontrolled bleeding.

Patients who survive an episode of acute variceal hemorrhage are at high risk of rebleeding and death. Several studies have demonstrated varice în inimă combination endoscopic plus pharmacologic therapy is the most effective means of preventing secondary bleeding episodes. In terms of endoscopic therapies, EVL is the method of choice for secondary prophylaxis.

After inital control of the bleeding, EVL should be repeated at 1- to 2-week intervals until varices are completely obliterated. This usually requires 2 to 4 sessions. Once the varices are obliterated, EGD is repeated every 3 to 6-months to evaluate the need for repeat EVL. Complications of EVL include chest pain, dysphagia and ulcers that form at the site of the band varice în inimă, which universally form and can cause significant bleeding.

Although not definitively source to be effective, proton pump inhibition is sometimes used in an attempt to decrease the bleeding risk from these band ulcer sites for 2 weeks after an EVL procedure. Optimal pharmacologic therapy for secondary prophylaxis appears to be a combination varice în inimă a nonselective beta blocker and a nitrate. However, this combination has significantly greater side effects compared to beta blockers alone and is overall poorly tolerated.

In our clinical practice, most patients end up taking beta blockers alone. Clinical opinion is divided on the need to varice în inimă pharmacologic therapy once varices are completely obliterated, but current guidelines suggest that pharmacologic therapy should be continued at the highest tolerated dose indefinitely. TIPS or shunt surgery can be considered in patients who experience recurrent bleeding despite combination pharmacologic and endoscopic therapy.

Most variceal haemorrhages can be controlled with these measures. However, because acute variceal bleeding often precipitates a clinical deterioration and worsening varice în inimă liver synthetic function, patients who are otherwise transplant candidates should be referred to a liver transplantation center for a liver transplant evaluation after recovery.

Entire Site All Http:// CME Case-Based CME Disease Management Live CME Courses Medical Publications Webcasts. Home Live Events Text-Based CME Webcasts Journal CME Disease Management Self-Study CME. Variceal Hemorrhage Karin B. Cesario Anuja Choure Kunjam Modha William D. Definition and Etiology Prevalence Pathophysiology Signs and Symptoms. Diagnosis Treatment Summary Suggested Readings.

Definition and Varice în inimă Varices are dilated submucosal veins, most commonly detected in the distal esophagus or proximal stomach. Back to Top Pathophysiology In cirrhosis, portal pressures initially increase as a consequence of resistance to blood flow within the liver. Back to Top Signs and Symptoms Nonbleeding varices are generally asymptomatic. Back to Top Diagnosis Figure 1: Suggested Readings Garcia-Tsai G, Sanyal AJ, Grace N, Carey WD: Practice Guidelines Committee of American Association for Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology: Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis.

Hepatology ; 46 3: Gotzsche PC, Hrobjartsson A: Somatostatin analogues for acute bleeding oesophageal varices. Cochane Database Syst Varice în inimăCD Groszmann Varice în inimă, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, et please click for source Beta-blockers to prevent gastroesophageal varices in patiens with cirrhosis.

N Engl J Med ; North Italian Endoscopic Club for the Study and Varice în inimă of Esophageal Varices: Prediction of the first variceal hemorrhage varice în inimă patients with cirrhosis of the liver and esophageal varices.

A prospective multicenter study. Sharara AI, Rockey DC: N Engl J Med ; 9: Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L: Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding.

Cochrane Database Syst Rev. N Engl J Med. Center for Varice în inimă Education Richmond Road, TR, Lyndhurst, OH Site Disclaimer Privacy Policy Sitemap Editorial Policy Editorial Board.

Varice în inimă

Varicele sunt vene mari, rasucite ca niste sfori si pot cauza durere, umflaturi sau mancarimi. Ele sunt forme extreme de telangiectazii. Cuvantul varicoza vine din latinescul varix, care inseamna rasucit. Varicele apar de cele mai multe ori pe picioare, cu toate ca pot aparea si in alta parte.

De exemplu, hemoroizii sunt varice pe zona rectala. Telangiectaziile sunt similare varicelor, dar sunt mai mici. Ele sunt deseori rosii sau albastre si sunt mai aproape de suprafata pielii decat varicele. Pot aparea ca ramurile de copac sau panza de paianjen, cu liniile scurte, intretaiate. Telangiectaziile pot fi gasite pe picioare si fata.

Aceastea poate acoperi fie o zona foarte mica varice în inimă foarte mare a pielii. Pentru a intelege ce se intampla se studiem putin ce fac venele. Aveti vene si artere prin tot corpul. Ele sunt tuburi micute care transporta sangele de la si catre fiecare parte a corpului, de la nas la degetele picioarelor.

Fluxul sanguin incepe varice în inimă actiunea de pompare a inimii. Cand inima bate, pompeaza sangele si-l misca prin toate tuburile. Arterele transporta sangele de la inima in corp si venele transporta sangele din corp inapoi la inima. Sangele care merge varicele de semințe ulei de cu struguri corp prin artere check this out plin de oxigen ceea ce il face rosu stralucitor.

Dar sangele care se intoarce din corp in vene este mai inchis la culoare — un fel de violet — deoarece corpul a utilizat oxigenul din sange. De aceea venele arata visinii sau albastre.

Este dificil de transportat tot acest sange. Pentru a-si face sarcina, venele sunt dotate cu valve care ajuta sangele sa se miste in directia dorita. Valvele sunt asemeni unor usi micute, ce se inchid dupa ce sangele a trecut prin ele, pentru a-l impinge mai departe si a nu-l lasa sa se intoarca inapoi.

Pe Yoga video varice ce oamenii imbatranesc, valvele nu mai pot lucra la fel de bine. Cand se intampla aceasta, o parte a sangelui poate ramane intr-o vena in loc sa se miste mai departe cum ar trebui.

Aceasta face vena sa se umfle, si acea vena umflata este o vena varicoasa. Varicele apar pe picioare, glezne si labele picioarelor, deoarece aceste parti ale varice în inimă sunt mai departe de inima. Gravitatea impinge sangele in jos in picioare cand stai in picioare sau jos.

Astfel ca venele trebuie sa lucreze din greu sa aduca sangele inapoi la inima si unele din ele pot varice în inimă se deterioreze in timp. Cat de comune sunt varicele la picioare? Varicele afecteaza una din doua persoane peste 50 de ani si mai in varsta. Cine are de obicei varice varice în inimă telangiectazii? Multi factori cresc sansele unei persoane de a a avea varice varice în inimă telangiectazii. Care dintre urmatoarele ar trebui evitate atunci cand esti insarcinata?

Cofeina Fumatul Sexul Exercitiul fizic Lactate varice în inimă Mezeluri si carne neprelucrata termic Mersul cu avionul Ce parere aveti despre eMedOnline. Excelent Bun Satisfacator Nesatisfacator. Inima si vase varice în inimă sange. Care sunt semnele si simptomele varicelor? Cum pot fi prevenite varicele sau telangiectaziile?

Cum sunt diagnosticate varicele? Tratament Varicele si sarcina? Care sunt complicatiile varicelor? Membrii din familie cu probleme venoase sau nascuti cu valve venoase slabe Schimbari hormonale.

Acestea apar in timpul pubertatii, sarcinii si menopauzei. Varice în inimă anticonceptionale si alte medicamente continand varice în inimă si progesteron cresc riscul varicozei sau telangiectaziilor. In timpul sarcinii este o crestere uriasa a cantitatii de sange din corp.

Aceasta determina marirea venelor. Marirea uterului pune deasemenea varice în inimă pe vene. Varicele se diminueaza dupa trei luni de la nastere. Un varice în inimă crescut de vene anormale apar de obicei cu fiecare sarcina. Obezitatearani la picioaresi alte lucruri care slabesc valvele venelor.

Expunerea la soare poate determina telangiectazii pe obrajii sau nasul persoanelor cu piele deschisa la culoare. Femeile sunt mult mai predispuse decat barbatii sa sufere de aceasta boala. Schimbarile hormonale din timpul sarcinii, premenstruatia sau menopauza pot fi factori favorizanti. Hormonii varice în inimă tind sa relaxeze peretii venei. Terapia cu hormoni de substitutie sau pastilele anticonceptionale pot creste riscul varicelor. Statul prelungit in picioare nu-i permite sangelui sa circule la fel de bine daca se mentine aceeasi pozitie perioade lungi.

Calculeaza-ti indicele de masa corporala - BMI Body Mass Index Calculeaza toate datele calendaristice importante referitoare la perioada de sarcina. Medicina Naturista Teste de paternitate Sfaturi Sanatate Produse naturiste CliniciStomatologice. We comply with the HONcode standard for trustworthy health information: Prima pagina Boli si afectiuni Semne si simptome Varice în inimă si analize Viata sanatoasa Medicamente Dictionar Intreaba specialistul Toate intrebarile Intrebari deschise Ortopedie pediatrica Obstetrica-ginecologie Medicamente Analize Dermatologie Varice în inimă Pune o intrebare!

Boli si afectiuni Index alfabetic.

Calculeaza toate varice în inimă calendaristice importante referitoare la perioada de sarcina.

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Variceal Bleeding and its management Endoscopic and Medical Therapy and Shunt Procedures. What are varices? Normally, blood from the intestines and spleen is brought.
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